Introduction

A liver transplant is an operation to remove a diseased or damaged liver and replace it with a healthy one.

It's usually recommended when the liver has been damaged to the point that it cannot perform its normal functions. This is known as liver failure or end-stage liver disease.

The liver can become gradually damaged as a result of illness, infection or alcohol. This damage causes the liver to become scarred, which is known as cirrhosis. Liver failure can also occur very rapidly as a result of inflammation and death of liver tissue (necrosis).

A liver transplant may also sometimes be recommended as a treatment for liver cancer.

The only hope for the long-term survival of a person with liver failure is a liver transplant because – unlike the kidney, heart or lungs – there is no device (such as a dialysis machine) that can permanently replicate the functions of the liver.

Who can have a liver transplant?

There is a strict assessment process that decides who can have a liver transplant, as donated livers are scarce.

Under UK regulations, you are usually only considered a suitable candidate if you meet two conditions:

without a liver transplant, it is highly likely that your expected lifespan would be shorter than normal, or your quality of life is so poor as to be intolerable

it is expected that you have at least a 50% chance of surviving for at least five years after the transplant with an acceptable quality of life

Most people who meet these criteria will be eligible for a transplant, although there are a few situations where you may be considered unsuitable. For example, you may not be able to have a transplant if you are unable to stop misusing alcohol, or you have liver cancer that has spread beyond the liver.

A series of tests will need to be carried out to determine whether you are suitable for a liver transplant.

Types of liver transplant

There are three main ways a liver transplant can be carried out:

deceased organ donation – involves transplanting a liver that has been removed from a person who died recently

living donor liver transplant –a section of liver is removed from a living donor; because the liver can regenerate itself, both the transplanted section and the remaining section of the donor's liver are able to regrow into a normal-sized liver

split donation – a liver is removed from a person who died recently and is split into two pieces; each piece is transplanted into a different person, where they will grow to a normal size

Most liver transplants are carried out using livers from deceased donors.

Waiting for a liver

There are more people in need of a liver transplant than there are donated livers, which means there is a waiting list. The average waiting time for a liver transplant is 145 days for adults and 72 days for children.

While you're on the waiting list, you will need to keep yourself as healthy as possible and be prepared for the transplant centre to contact you at any moment, day or night.

You should also keep the transplant centre informed about any changes in your circumstances, such as changes in your health, address or contact details.

Life after a liver transplant

Your symptoms should improve soon after the transplant, but most people will need to stay in hospital for up to two weeks.

Recovering from a liver transplant can take a long time, but most people will gradually return to many of their normal activities within a few months.

You'll need regular follow-up appointments to monitor your progress and you'll be given immunosuppressant medication that helps to stop your body rejecting your new liver. These usually need to be taken for life.

Risks of a liver transplant

The long-term outlook for a liver transplant is generally good. More than nine out of every 10 people are still alive after one year, around eight in every 10 people live at least five years, and many people live for up to 20 years or more.

However, a liver transplant is a major operation that carries a risk of some potentially serious complications. These can occur during, soon after, or several years after the procedure.

Some of the main problems associated with liver transplants include:

your body rejecting the new liver

bleeding (haemorrhage)

the new liver not working within the first few hours (primary non-function), requiring a new transplant to be carried out as soon as possible

The NHS Organ Donor Register

In the UK, consent is required before organs can be donated. A person can give their consent to become an organ donor after death by joining the NHS Organ Donor Register or by discussing their wishes with loved ones.

Alternatively, a person’s organs can be donated if consent is obtained after their death from an authorised person, such as a relative or friend.

The NHS Organ Donor Register is the same in principle as carrying a donor card, but is a failsafe way of ensuring your wishes are made clear. A donor card can be lost or forgotten about, but joining the register will mean there's a permanent record of your wishes that doctors can check in the event of your death.

Joining the NHS Organ Donor Register is quick and simple, and will only take a few minutes of your time. You can remove yourself from the register at any time, and you can specify what you're willing to donate.